Do you regularly take prescription medications? If the answer is yes, you would likely benefit from lower copayments at the pharmacy counter with the help of a prescription drug plan. Original Medicare (Part A and Part B) does not provide coverage for prescription drugs. You need to purchase a separate Part D prescription drug plan to find this coverage or enroll in a Medicare Advantage plan with drug coverage.
What are formularies?
Part D plans use lists called formularies to organize their covered prescription drugs into tiers based on the copayment the plan expects you to pay when you fill a given drug at the pharmacy. There are five tiers used by Part D plans. These are number one through five and are as follows: Generic, preferred; Generic; Brand Name; Non-preferred; Specialty.
Tier 1 requires the lowest copayment and consists of commonly prescribed generic prescription drugs. Tier 2, generic drugs are less expensive than brand name drugs in Tier 3. Tier 4 is composed of non-preferred generic and brand name drugs. Specialty drugs in Tier 5 require special handling or administration and are the most expensive with the highest copays.
If you are taking a prescription that is not covered by your plan (not listed on their formulary), you and your prescriber can request an exception. You can also do this if you need a prescription in a higher quantity than is allowed by the drug’s specific quantity limit.
What if changes are made?
When plans make changes to their formulary, they are required to give you advance notice if it affects a prescription you are currently taking. You will either be given notice 30 days in advance of the change or given one month of prescription at the prior rate (in the case of a price change). Plans will immediately withdraw drugs that are removed by the Food and Drug Administration.
At the end of the year, your plan will mail you an Annual Notice of Change to announce any alterations that will be made for the next year. This notice comes out in the fall before Open Enrollment (also called the Annual Election Period) from October 15 to December 7. It is wise during this time to review your plan’s formulary for any changes and to shop for a new plan that covers all of your prescriptions if yours will no longer do so.
Your costs for a Part D plan include the plan’s deductible as well as a monthly premium, the amount of which is determined by your income as filed on your taxes. You also pay copayments for each drug you fill at the pharmacy.
You may qualify for Extra Help if you qualify for Medicare Savings Programs or are dually eligible with Medicare and Medicaid. Extra Help sets copayments to a set low price for generic and brand name prescription drugs.
If you take insulin, starting in 2021, you may be able to find a plan in your state that allows you to pay no more than $35 for a 30-day supply of insulin. You can join during Open Enrollment from October 15 to December 7.
The alternative to Part D is joining a Medicare Advantage plan with prescription drug coverage. These plans are a combination of the benefits from Part A and Part B with Part D drug coverage. Additionally, you can often pay for added benefits for dental, hearing, or vision care with a Medicare Advantage plan. You can sign up for one of these plans if you are enrolled in Part A and Part b and live within the plan’s service area. Sign up during Open Enrollment from October 15 to December 7.
For more information regarding prescription drug coverage, reach out to Bobby Brock Insurance.